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1.
Purpose
Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds.Methods
Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n?=?23) and three-port VATS (n?=?102), at our institution between January 2010 and August 2016.Results
We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7?±?15.7 vs. 85.9?±?25.5 min, respectively, P?=?0.0388) and the number of autosutures used (3.6?±?1.2 vs. 4.5?±?1.2, respectively, P?=?0.0178).Conclusion
The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.2.
Purpose
This study assessed the efficacy and safety of onabotulinumtoxinA according to injection site for treatment of overactive bladder.Methods
A systematic literature review located randomized controlled trials of onabotulinumtoxinA treatment for neurogenic detrusor overactive bladder and idiopathic overactive bladder in adults. We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register using the Ovid platform. Meta-analysis was based on Cochrane Review Methods.Results
Eight studies (419 participants) were included. Trigone-including injection demonstrated a significant improvement in symptom score (SMD = ? 0.53, 95% CI ? 1.04 to ? 0.02, P = 0.04, I 2 = 78%), higher complete dryness rates (OR = 2.19 patients, 95% CI 1.32–3.63, P = 0.002, I 2 = 41%), and lower frequency of incontinence episodes (WMD = ? 0.85 per day, 95% CI ? 1.55 to ? 0.16, P = 0.02, I 2 = 87%) in patients. Comparing trigone-including injection to trigone-sparing injection, lower detrusor pressure (WMD = ? 2.55 cm H2O, 95% CI ? 4.16 to ? 0.95, P = 0.002, I 2 = 0%) and higher volume at first desire to void (WMD = 17.54 ml, 95% CI 1.00–34.07, P = 0.04, I 2 = 0%) were observed with trigone-including injection. Between intradetrusor and suburothelial injection sites, there were no differences in efficacy or safety regarding the incidence of vesicoureteral reflux, hematuria, general weakness, bladder discomfort, large post-void residual, and urinary tract infection.Conclusion
Trigone-including onabotulinumtoxinA injection has superior efficacy to trigone-sparing injection without increased complications. The depth of injection does not influence the efficacy or safety of onabotulinumtoxinA.3.
Likui Fang Luming Wang Yiqing Wang Wang Lv Jian Hu 《Journal of cardiothoracic surgery》2018,13(1):128
Background
Surgery is an important part of multidisciplinary treatment strategy for locally advanced lung squamous cell carcinoma (LSCC), but insufficient evidence supports the feasibility and safety of video assisted thoracic surgery (VATS) following neoadjuvant chemotherapy for locally advanced LSCC. This study aims to compare perioperative data and long-term survival of locally advanced LSCC patients between VATS and thoracotomy after neoadjuvant chemotherapy.Methods
We retrospectively collected the clinical and pathological information of patients with locally advanced LSCC who underwent surgical resection after neoadjuvant chemotherapy from October 2013 to October 2017. All patients were divided into two groups (thoracotomy and VATS) and were compared the differences in perioperative, oncological and survival outcomes.Results
A total of 81 patients were analyzed in this study (67 thoracotomy and 14 VATS). VATS provided less postoperative pain (P =?0.005) and produced less volume of chest drainage (P =?0.019) than thoracotomy, but the number of resected lymph nodes was less in VATS group (P =?0.011). However, there was no significant difference in the number of resected lymph node stations and the rate of nodal upstaging between two groups. The mean disease free survival (DFS) was 32.7?±?2.7?months for the thoracotomy group and 31.8?±?3.0?months for the VATS group (P?=?0.335); the corresponding overall survival (OS) was 41.7?±?2.2?months and 36.4?±?4.1?months (P?=?0.925).Conclusion
In selected patients with locally advanced LSCC, VATS played a positive role in postoperative recovery and associated similar survival outcome compared with thoracotomy after neoadjuvant chemotherapy.4.
Objective
The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of bipolar sealer versus standard electrocautery in the management of spinal disease.Methods
The electronic databases including Embase, PubMed and Cochrane library were searched to identify relevant studies published from the time of the establishment of these databases up to January 2017. The primary outcomes were total blood loss, requirement of transfusion (rate and amount), and operation time. The secondary outcomes were length of hospital stay and postoperative wound infection. Data analysis was conducted with RevMan 5.3 software.Results
A total of five studies involving 500 patients (261 patients in the BS group and 239 in the control group) were included in the meta-analysis. The pooled results revealed that application of bipolar sealer could decrease the total blood loss in spine surgery [WMD = ?467.49, 95% CI (685.47 to ?249.51); p < 0.05; I 2 = 91%]. Compared with standard electrocautery, bipolar sealer was associated with lower rates of need for transfusion [OR = 0.30, 95% CI (0.16–0.55), p < 0.05; I 2 = 0%]. In addition, patients in the BS group were likely to receive less amount of blood transfusion compared with patients in the control group[WMD = ?0.73, 95% CI (?1.37 to ?0.09), p < 0.05; I 2 = 76%]. The mean operative time was shorter in the BS groups compared with the control group [SMD = ?0.36, 95% CI (?0.60 to ?0.13), p < 0.05; I 2 = 0%]. There was no significant difference in terms of length of hospital stay [WMD = ?0.73, 95% CI (?1.96 to 0.51), p = 0.25; I 2 = 67%] and postoperative wound infection [OR = 0.88, 95% CI (0.31–2.48), p = 0.81; I 2 = 0.0%] between both groups.Conclusions
The available evidence suggests that bipolar sealer is superior to standard electrocautery with less blood loss, shorter operation time and less transfusion requirement. There is no significant difference between both groups regarding length of hospitalization and wound infection. Hence, bipolar sealer is recommended in spine surgery. Because of the limitation of our study, more well-designed RCTs with large sample are required to provide further evidence of safety and efficacy between bipolar sealer and standard electrocautery in the treatment of spinal disease.5.
Background
Testing stimulates learning, improves long-term retention, and promotes technical performance. No purpose-orientated test of competence in the theoretical aspects of VATS lobectomy has previously been presented. The purpose of this study was, therefore, to develop and gather validity evidence for a theoretical test on VATS lobectomy consisting of multiple-choice questions.Methods
Four European VATS lobectomy experts were interviewed to explore their views on important theoretical VATS lobectomy knowledge (step 1). This information was used to construct the test items in compliance with existing guidelines for multiple-choice questions (step 2). The experts rated the relevance of the items to confirm content validity in a modified Delphi approach (step 3). Finally, the test was administered to physicians, who were categorised into different experience levels based on their experience in VATS procedures overall and in VATS lobectomies specifically. Their answers were used to achieve construct validity (step 4).Results
Initially, 81 items were constructed and two Delphi iterations reduced the test to 50 items. Item analysis led to the exclusion of 19 items and the mean discrimination index of the 31 final items was 0.26. Cronbach’s alpha for internal consistency was 0.75. The mean item difficulty was calculated to 0.63. According to performed VATS procedures, significantly different test performances were detected when comparing the group performances (p = 0.002) and the experts performed significantly better than the novices (p < 0.001) and intermediates (p = 0.01). In the category of performed VATS lobectomies, significant group performances were also found. In this category, the experts were also significantly better than the novices (p < 0.001), the trainees (p = 0.002), and the intermediates (p = 0.01).Conclusions
This study led to the development of a theoretical test on VATS lobectomy consisting of multiple-choice questions. Both content and construct validity evidence were established.6.
Purpose
Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior–posterior approach to posterior-only approach, we conducted a meta-analysis.Methods
We searched electronic database for relevant studies that compared anterior–posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data.Results
A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI ?0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI ?6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72–6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI ?2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior–posterior group (95 % CI ?13.18 to ?4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75–17.49, P < 0.0001), blood loss (95 % CI 363.28–658.91, P < 0.00001), operative time (95 % CI 2.65–3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98–22.94, P = 0.02) were found in posterior group.Conclusions
Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior–posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.7.
J. F. Oliveira E. G. H. Moura W. M. Bernardo E. Ide S. Cheng M. Sulbaran C. M. L. Santos P. Sakai 《Surgical endoscopy》2016,30(7):2779-2791
Background
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.Methods
A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.Results
We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = ?0.36, 95 % CI ?0.55 to ?0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = ?8.57, 95 % CI ?13.88 to ?3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI ?0.09 to 0.14, P = 0.68).Conclusions
The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.8.
Toshiyuki Mizota Yoshika Iwata Hiroki Daijo Tomohiro Koyama Tomoharu Tanaka Kazuhiko Fukuda 《Journal of anesthesia》2013,27(6):895-900
Purpose
Early postoperative mobilization is crucial for early ambulation to reduce postoperative pulmonary complications after lung resection. However, orthostatic intolerance (OI) may delay patient recovery, leading to complications. It is therefore important to understand the prevalence of and predisposing factors for OI following video-assisted thoracic surgery (VATS), which have not been established. This study evaluated the incidence of OI, impact of OI on delayed ambulation, and predisposing factors associated with OI in patients after VATS.Methods
This retrospective cohort study consecutively analyzed data from 236 patients who underwent VATS. The primary outcome was defined as OI with symptoms associated with ambulatory challenge on postoperative day 1 (POD1), including dizziness, nausea and vomiting, feeling hot, blurred vision, or transient syncope. Multivariate logistic regression was performed to identify independent factors associated with OI.Results
Of the 236 patients, 35.2 % (83) experienced OI; 45.8 % of these could not ambulate at POD1, compared with 15.7 % of patients without OI (P < 0.001). Factors independently associated with OI included advanced age [odds ratio 2.83 (1.46–5.58); P = 0.002], female gender [odds ratio 2.40 (1.31–4.46); P = 0.004], and postoperative opioid use [odds ratio 2.61 (1.23–5.77); P = 0.012]. Use of thoracic epidural anesthesia was not independently associated with OI [odds ratio 0.72 (0.38–1.37); P = 0.318].Conclusion
Postoperative OI was common in patients after VATS and significantly associated with delayed ambulation. Advanced age, female gender, and postoperative opioid use were identified as independent predisposing factors for OI. 相似文献9.
Yang Xun Qing Wang Henglong Hu Yuchao Lu Jiaqiao Zhang Baolong Qin Yudi Geng Shaogang Wang 《BMC urology》2017,17(1):102
Background
To update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).Methods
A systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.Results
Fourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], ?3.79 min; 95% confidence interval [CI], ?6.73 to ?0.85; P = 0.012; I2 = 53.8%), shorter hospital stay (WMD, ?1.27 days; 95% CI, ?1.65 to ?0.90; P < 0.001; I2 = 98.7%), faster time to return to normal activity (WMD, ?4.24 days; 95% CI, ?5.76 to ?2.71; P < 0.001; I2 = 97.5%), lower postoperative pain scores (WMD, ?16.55 mm; 95% CI, ?21.60 to ?11.50; P < 0.001; I2 = 95.7%), less postoperative analgesia requirements (standard mean difference, ?1.09 mg; 95% CI, ?1.35 to ?0.84; P < 0.001; I2 = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I2 = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, ?0.02 g/dL; 95% CI, ?0.04 to 0.01; P = 0.172; I2 = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I2 = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I2 = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I2 = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.Conclusions
Tubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.10.
Background
Postoperative pain after major knee surgery can be severe. Our aim was to compare the outcomes of epidural analgesia and peripheral nerve blockade (PNB) in patients undergoing total knee joint replacement (TKR). Moreover, we aimed to compare outcomes of adductor canal block (ACB) with those of femoral nerve block (FNB) after TKR.Methods
We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; and the Cochrane Central Register of Controlled Trials (CENTRAL). We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above databases. Pain intensity assessed on visual analogue scale (VAS), nausea and vomiting, systolic hypotension, and urinary retention was the reported outcome parameters.Results
We identified 12 randomised controlled trials (RCTs) comparing outcomes of epidural analgesia and PNB reporting a total of 670 patients. There was no significant difference between two groups in VAS scores at 0–12 h (MD ?0.48; 95 % CI ?1.07–0.11, P = 0.11), 12–24 h (MD 0.04; 95 % CI ?0.81–0.88, P = 0.93), and 24–48 h (MD 0.16; 95 % CI ?0.08–0.40, P = 0.19). However, epidural analgesia was associated with significantly higher risk of postoperative nausea and vomiting (RR 1.65; 95 % CI, 1.20–2.28, P = 0.002), hypotension (RR 1.76; 95 % CI, 1.26–2.45, P = 0.0009), and urinary retention (RR 4.51; 95 % CI, 2.27–8.96, P < 0.0001) compared to PNB. Moreover, pooled analysis of data from 6 RCTs demonstrated no significant difference in VAS score between ACB and FNB at 24 h (MD ?0.00; 95 % CI, ?0.56–0.56, P = 0.99) and 48 h (MD ?0.06; 95 % CI, ?0.14–0.03, P = 0.23).Conclusions
PNB is as effective as epidural analgesia for postoperative pain management in patients undergoing TKR. Moreover, it is associated with significantly lower postoperative complications. ACB appears to be an effective PNB with similar analgesic effect to FNB after TKR. Future RCTs may provide better evidence regarding knee range of motion, length of hospital stay, and neurological complications.11.
X. Wang S. Yan C. Liu Y. Xu L. Wan Y. Wang W. Gao S. Meng Y. Liu R. Liu D. Xu 《Osteoporosis international》2016,27(4):1413-1423
Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD]?=??0.04; 95 % CI ?0.06 to ?0.02; P?<?0.001), femoral neck (WMD?=??0.06; 95 % CI ?0.07 to ?0.04; P?<?0.001), lumbar spine (WMD?=??0.06; 95 % CI ?0.09 to ?0.03; P?<?0.001), and total hip (WMD?=??0.05; 95 % CI ?0.06 to ?0.03; P?<?0.001). In addition, the meta-analysis also showed that SLE was significantly associated with increased fracture risk of all sites (relative risk [RR]?=?1.97, 95 % CI 1.20–3.25; P?=?0.008). Subgroup analysis by adjustment showed that SLE was significantly associated with increased fracture risk of all sites before and after adjusting for confounding factors (unadjusted RR?=?2.07, 95 % CI 1.46–2.94, P?<?0.001; adjusted RR?=?1.22, 95 % CI 1.05–1.42, P?=?0.01). Subgroup analysis by types of fracture showed that SLE was significantly associated with increased risks of hip fracture (RR?=?1.99, 95 % CI 1.55–2.57; P?<?0.001), osteoporotic fracture (RR?=?1.36, 95 % CI 1.21–1.53; P?<?0.001), and vertebral fracture (RR?=?2.97, 95 % CI 1.71–5.16; P?<?0.001). This systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk. 相似文献
12.
Tsia-Shu Lo Enie Akhtar Nawawi Pei-Ying Wu Nazura bt Karim Ahlam Al-Kharabsheh 《International urogynecology journal》2016,27(3):399-406
Introduction and hypothesis
The objective of this study was to identify the predictors for persistent urodynamic stress incontinence (P-USI) in women following extensive pelvic reconstructive surgery (PRS) with and without midurethral sling (MUS).Mmethods
A total of 1,017 women who underwent pelvic organ prolapse (POP) surgery from January 2005 to December 2013 in our institutions were analyzed. We included 349 USI women who had extensive PRS for POP stage III or more of whom 209 underwent concomitant MUS.Results
Of the women who underwent extensive PRS without MUS, 64.3 % (90/140) developed P-USI compared to only 10.5 % (22/209) of those who had concomitant MUS. Those with concomitant MUS and PRS alone were at higher risk of developing P-USI if they had overt USI [odds ratio (OR) 2.2, 95 % confidence interval (CI) 1.3–4.0, p?=?0.014 and OR 4.7, 95 % CI 2.0–11.3, p?<?0.001, respectively], maximum urethral closure pressure (MUCP) of?<?60 cm H2O (OR 5.0, 95 % CI 3.0–8.1, p?<?0.001 and OR 5.3, 95 % CI 2.7–10.4, p?<?0.001, respectively), and functional urethral length (FUL) of?<?2 cm (OR 5.4, 95 % CI 2.7–8.8, p?<?0.001 and OR 3.9, 95 % CI 2.4–6.9, p?<?0.001, respectively). Parity?≥?6 (OR 3.9, 95 % CI 1.7–5.2, p?<?0.001) and Prolift T (OR 3.1, 95 % CI 1.9–4, p?<?0.001) posed a higher risk of P-USI in those with concomitant surgery. Perigee and Avaulta A seemed to be protective against P-USI in those without MUS.Conclusions
Overt USI with advanced POP together with low MUCP and FUL values have a higher risk of developing P-USI. Therefore, counseling these women is worthwhile while considering the type of mesh used.13.
Purpose
We investigated the efficiency of the Simplified Comorbidity Score (SCS) for predicting postoperative complications and prognosis in elderly patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer.Methods
We reviewed 216 patients aged 75 years or older, who underwent pulmonary resection by VATS for lung cancer between January, 2005 and December, 2012. The SCS assigns different scores to patients’ comorbidities; namely, smoking (n = 7); diabetes mellitus (n = 5); renal insufficiency (n = 4); and respiratory, neoplastic, and cardiovascular comorbidities or alcoholism (n = 1 each). Patients were divided into a high SCS group (SCS ≥ 9; n = 154) and a low SCS group (<9; n = 62), for a comparative analysis of differences in perioperative factors and prognoses.Results
Limited resection was more frequent in the high SCS group (58 %) than in the low SCS group (40 %; P = 0.02). Postoperative complications were more frequent in the high SCS group (45 %) than in the low SCS group (15 %; P < 0.01). A logistic regression analysis revealed that a high SCS was significantly predictive of postoperative complications (odds ratio 2.7; P = 0.02). The 5-year overall survival rate was 79 % for the low SCS group and 52 % for the high SCS group (P < 0.01).Conclusions
The SCS can predict the likelihood of postoperative complications and prognosis of elderly patients with VATS-treated lung cancers.14.
Julia B. Kössler-Ebs Kathrin Grummich Katrin Jensen Felix J. Hüttner Beat Müller-Stich Christoph M. Seiler Phillip Knebel Markus W. Büchler Markus K. Diener 《World journal of surgery》2016,40(10):2319-2330
Background
Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence.Methods
A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI).Results
24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD ?0.06, 95 % CI [?0.09, ?0.03], p = 0.0002, I 2 = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD ?0.14, 95 % CI [?0.22, ?0.06], p = 0.001, I 2 = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD ?0.01, 95 % CI [?0.03, 0.01], p = 0.31, I 2 = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD ?0.06, 95 % CI [?0.09, ?0.03], p < 0.0001, I 2 = 35 %); overall postoperative morbidity was comparable in both groups (RD ?0.06, 95 % CI [?0.13, 0.00], p = 0.06; I 2 = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD ?1.92, 95 % CI [?2.67, ?1.17], p < 0.00001, I 2 = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy.Conclusions
Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.15.
Purpose
Sevoflurane preconditioning (SevoPreC) has been proved to prevent organ ischemia/reperfusion (I/R) injury in various animal models and preclinical studies. Clinical trials on cardioprotection by SevoPreC for adult patients undergoing coronary artery bypass graft (CABG) revealed mixed results. The aim of this meta-analysis was to evaluate the cardiac effect of SevoPreC in on-pump CABG.Methods
Randomized controlled trials (RCT) comparing the cardiac effect of SevoPreC (compared with control) in adult patients undergoing CABG were searched from PubMed, Embase, and the Cochrane Library (up to November 2015). The primary endpoints were postoperative troponin levels. Additional endpoints were CK-MB levels, mechanic ventilation (MV) duration, intensive care unit (ICU) stay, and hospital length of stay (LOS).Results
Six trials with eight comparisons enrolling a total of 384 study patients reporting postoperative troponin levels were identified. Compared with controls, SevoPreC decreased postoperative myocardial troponin levels [standardized mean difference (SMD) = ?0.38; 95 % CI, ?0.74 to ?0.03; P = 0.04; I 2 = 63.9 %]. However, no significant differences were observed in postoperative CK-MB levels [weighted mean difference (WMD) = ?1.71; P = 0.37; I 2 = 37.7 %], MV duration (WMD = ?0.53; P = 0.47; I 2 = 0.0 %), ICU stay (WMD = ?0.91; P = 0.39; I 2 = 0.9 %), and hospital LOS (WMD = 0.08; P = 0.86; I 2 = 8.0 %).Conclusion
Available evidence from the present systematic review and meta-analysis suggests that sevoflurane preconditioning may reduce troponin levels in on-pump CABG. Future high-quality, large-scale clinical trials should focus on the early and long-term clinical effect of SevoPreC in on-pump CABG.16.
Florian Primavesi Tarkan Jäger Thomas Meissnitzer Selina Buchner Silvia Reich-Weinberger Dietmar Öfner Jörg Hutter Manuela Aspalter 《World journal of surgery》2016,40(5):1112-1120
Background
Although recurrence of primary spontaneous pneumothorax (PSP) is frequent, guidelines do not routinely recommend surgery after first presentation. A CT-based lung dystrophy severity score (DSS) has recently been proposed to predict recurrence following conservative therapy. This study compares the DSS in surgically and conservatively treated patients.Methods
This is a retrospective analysis of first episode PSP patients, comparing video-assisted thoracic surgery (VATS; group A) to conservative treatment with or without chest drainage (group B). CT scans were reviewed for blebs or bullae, and patients were assigned DSS values and stratified into risk groups (low and high-grade). Primary end point was ipsilateral or contralateral recurrence.Results
Fifty-six patients were included, 33 received VATS and 23 conservative treatment. In total, 37.5 % experienced recurrence, with a 5-year estimated recurrence rate of 40.7 % (group A: 13.3 %; group B: 73.9 %; p < 0.001). In group B, detection of any dystrophic lesions resulted in significantly higher 5-year recurrence rates (86.7 vs. 50.0 %; p = 0.03), there was no significant difference in group A (17.7 vs. 7.7 %; p = 0.50). Greater DSS values correlated with higher 5-year recurrence rates in group B (p = 0.02), but not in group A (p = 0.90). Comparing low- and high-grade patients in group B resulted in a significant 5-year recurrence rate of 53.8 versus 100 % (p = 0.023).Conclusions
The DSS is useful to indicate VATS after the first episode. For routine application, assigning patients to low- and high-grade groups seems most practical. We recommend CT-evaluation for every PSP patient and early surgery for those with lesions exceeding one bleb. After VATS, the preoperative DSS is not beneficial in predicting recurrence.17.
Hang Zhang XiangHu Wu Feng Zhu Ming Shen Rui Tian ChengJian Shi Xin Wang GuangQin Xiao XingJun Guo Min Wang RenYi Qin 《Surgical endoscopy》2016,30(12):5173-5184
Backgrounds and objective
The technique of minimally invasive pancreatic surgeries has evolved rapidly, including minimally invasive pancreaticoduodenectomy (MIPD). However, controversy on safety and feasibility remains when comparing the MIPD with the open pancreaticoduodenectomy (OPD); therefore, we aimed to compare MIPD and OPD with a systemic review and meta-analysis.Methods
Multiple electronic databases were systematically searched to identify studies (up to February 2016) comparing MIPD with OPD. Intra-operative outcomes, oncologic data, postoperative complications and postoperative recovery were evaluated.Results
Twenty-two retrospective studies including 6120 patients (1018 MIPDs and 5102 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (WMD ?312.00 ml, 95 % CI ?436.30 to ?187.70 ml, p < 0.001), transfusion rate (OR 0.41, 95 % CI 0.30–0.55, p < 0.001), wound infection (OR 0.37, 95 % CI 0.20–0.66, p < 0.001) and length of hospital stay (WMD ?3.57 days, 95 % CI ?5.17 to ?1.98 days, p < 0.001). Meanwhile, MIPD group has a higher R0 resection rate (OR 1.47, 95 % CI 1.18–1.82, p < 0.001) and more lymph nodes harvest (WMD 1.74, 95 % CI 1.03–2.45, p < 0.001). However, it had longer operation time (WMD 83.91 min, 95 % CI 36.60–131.21 min, p < 0.001). There were no significant differences between the two procedures in morbidities (p = 0.86), postoperative pancreatic fistula (p = 0.17), delayed gastric empting (p = 0.65), vascular resection (p = 0.68), reoperation (p = 0.33) and mortality (p = 0.90).Conclusions
MIPD can be a reasonable alternative to OPD with potential advantages. However, further large-volume, well-designed RCTs with extensive follow-ups are suggested to confirm and update the findings of our analysis.18.
Background
Recent NICE guidelines recommend open surgical approaches for the treatment of primary unilateral inguinal hernias. However, many surgeons perform a laparoscopic approach based on the advantages of less post-operative pain and faster recovery. Our aim was to examine current evidence comparing transabdominal pre-peritoneal (TAPP) laparoscopic repair and open surgical repair for primary inguinal hernias.Methods
A systematic search of six electronic databases was conducted for randomised controlled trials (RCTs) comparing TAPP and open repair for primary unilateral inguinal hernia. A random-effects model was used to combine the data.Results
A total of 13 RCTs were identified, with 1310 patients receiving TAPP repair and 1331 patients receiving open repair. There was no significant difference between the two groups for rates of haematoma (RR 0.92; 95% CI 0.49–1.71; P = 0.78), seroma (RR 1.90; 95% CI 0.87–4.14; P = 0.10), urinary retention (RR 0.99; 95% CI 0.36–2.76; P = 0.99), infection (RR 0.61; 95% CI 0.29–1.28; P = 0.19), and hernia recurrence (RR 0.67; 95% CI 0.42–1.07; P = 0.10). TAPP repair had a significantly lower rate of paraesthesia (RR 0.20; 95% CI 0.08–0.50; P = 0.0005), shorter bed stay (2.4 ± 1.4 vs 3.1 ± 1.6 days, P = 0.0006), and shorter return to normal activities (9.5 ± 7.9 vs 17.3 ± 8.4 days, P < 0.00001).Conclusions
Our findings demonstrated that TAPP repair did not have higher rate of morbidity or hernia recurrence and is an equivalent approach to open repair, with the advantages of faster recovery and reduced paraesthesia.19.
M. C. Kriegmair P. Mandel A. Moses C. Bolenz M. S. Michel D. Pfalzgraf 《World journal of urology》2016,34(4):545-551
Purpose
The aim of the study was to externally validate the Zonal NePhRO Score (ZNS) published in 2014 as latest and superior nephrometry score in terms of prediction of perioperative complications and outcome of open partial nephrectomies (OPNs).Methods
We identified 200 consecutive patients who underwent OPN. Analysis of preoperative CT or MRI scans and retrospective analysis of the patients’ clinical records were performed. Tumour complexity was stratified according to the ZNS into three categories: low (4–6), moderate (7–9) and high (10–12) complexity. Predictors for perioperative complications and surgical parameters were identified using univariate and multivariate logistic regression.Results
Tumour complexity was graded in 19.8 % of the cases as low, in 50.3 % as moderate and in 29.9 % as high. In the multivariate analysis, ZNS was significantly associated with a higher complication rate (OR 1.25, 95 % CI 1.04–1.49, p = 0.014), longer ischaemia time (IT) (β = 1.19, 95 % CI 0.33–2.05, p = 0.007), postoperative drop of estimated glomerular filtration rate (eGFR) (β = ?1.86, 95 % CI ?3.71 to ?0.01, p = 0.049) and opening of the collecting system (CS) (OR 1.72, 95 % CI 1.40–2.10, p < 0.001). In addition, age and body mass index were identified as independent predictors for complications (OR 1.03, 95 % CI 1.00–1.06, p = 0.043 and OR 1.08, 95 % CI 1.00–1.15, p = 0.031).Conclusion
The present study is the first external validation of the ZNS as a predictor of perioperative complications in patients undergoing OPN. A higher ZNS score was associated with a longer IT, a higher rate of opening the CS and drop of eGFR.20.
Ignazio Tarantino Rene Warschkow Bruno M. Schmied Ulrich Güller Markus Mieth Thomas Cerny Markus W. Büchler Alexis Ulrich 《Journal of gastrointestinal surgery》2016,20(6):1213-1222